AS a means of illuminating the current extreme crisis in our health service, it was grim, and it was truthful. Just eight, uncomfortable, words.

“People are frightened to come into work now”, John-Paul Loughrey, vice-president of the Royal College of Emergency Medicine Scotland, said of his fellow medical professionals this week. “I am aware”, he went on, “of colleagues who have three or four incidents to record but they cannot sit down recording when patients have been queuing six to seven hours to be seen”.

There were, he added, so many “clinical incidents and near-misses” that a doctor in each major hospital north of the border could spend most of his or her shift merely detailing what had gone wrong.

The crisis is all too real. The potential situation over the next few days in A&E units is appalling emergency medicine consultants. The Scottish Tories claim that 56,228 patients have spent at least 12 hours waiting to be seen in A&E since Humza Yousaf’s arrival as Health Secretary in mid-2021.

More worryingly, the BMA Scotland chairman believes there is “no way that the NHS in Scotland can survive” in its current form. Colleagues have told him that the entire health and social care system in Scotland is broken; indeed, said Dr Iain Kennedy, many of his members take the view that the NHS in Scotland has already died.

Are we ever going to get meaningful, consistent, far-sighted political leadership on the NHS? Is it even possible? As has often been stated, many of the structural problems stem from repeated years of under-investment. And there is no gainsaying the colossal impact that the pandemic had on the service, or the fact that Covid has yet to be banished, or that the cold snap and the flu outbreak have put the NHS under extra strain.

Equally, however, there is no point in denying the extent of the pressures on NHS workers. Staff, grievously overworked, are upset when they cannot accommodate patients, particularly the elderly ones, as rapidly as they would like. Many nurses and junior doctors are opting out, seeking less stressful work overseas.

The latter are preparing preparing for industrial action as part of their demand for higher pay, their salaries having eroded by 23.5% since 2008. Thousands of Scottish nurses are set for strike action in the new year after overwhelmingly rejecting a pay deal offered by the Scottish government. Meeting such pay demands would put the public purse under strain, but nurses and junior doctors surely have a cast-iron case for increased pay.

Beyond that, there seems little doubt that the NHS will need radical structural changes sooner or later. We cannot go on as we are, at the mercy of external events. The cost-of-living crisis alone will test the mental and physical fortitude of huge numbers of people, which could cause demand for NHS expertise to jump.

Dr Kennedy of BMA Scotland has not been alone in calling for a national conversation on the health service. It is a sensible idea, but will our politicians have the foresight to agree to it? Dr Kennedy makes the telling point that the NHS might not be able to provide all of its free services in the future but that it is up to politicians and the public to decide how to go forward.

Debate has long swirled around future funding models for the 74-year-old health service. Is Germany’s health insurance model the one to follow? Or Israel’s European-style social insurance, with its element of patient choice and leverage? Would the cost of transitioning from the current funding model to a new one be so great as to nullify any benefits? And, in the medium-term, how much extra time and resources should we be devoting to dealing with troublesome issues such as obesity?

If we have a wish for 2023 – and it has to be recognised that political leaders are facing many other difficulties: the Ukraine war, the energy crisis, the refugee crisis, and the challenge posed to the West by the “no limits” partnership of China’s Xi Jinping and Russia’s Vladimir Putin – it would be that a grown-up approach to the NHS is finally initiated.

The West deserves praise, however, for its continued determination to stand by Ukraine. Russia has been internationally isolated through its punitive assault on Ukraine – its missiles rain down each day on Ukrainian town and cities – but the West’s supply of weapons and other forms of assistance needs to be prolonged for as long as it takes.

Domestically? As a nation we are still waiting for any post-Brexit uplift. The adverse impact of the decision to secede from Europe has been widely felt by businesses and households alike. It would be good to see Rishi Sunak and his senior ministers focusing on securing more (and better) trade deals.

Rejoining the European single market would be a step too far for either of the main parties. Sir Keir Starmer, ever-cautious, declined to countenance it after giving due weight to current European political realities. But as more and more pro-Brexiteers express buyers’ remorse, and as business anger grows, it will be interesting to see what the public reaction would be to such a move.

Economic growth and increased productivity, investment and skills training are other national priorities. Mr Sunak has been conspicuously quiet of late, the assumption being that he has been busy creating plans to deal with the crises, some of which he inherited from his hapless, over-confident predecessor. He has a year and a half in which to improve matters. Can he pull it off? Sir Keir Starmer is waiting offstage if he cannot.

Starmer has made Labour more electable than it would ever have been under his own predecessor. It says much for him that the Tories’ attempted demonisation over Labour and the public sector strikes has not enjoyed much traction. One online opinion poll of 2,000 people found that more (41%) blame the Tories for the winter’s wave of strikes than the unions (35%) or employers (11%). Starmer’s innate reserve has made it difficult for floating voters to latch onto him, but it may be that the Tories, worn out after 12 long years in power, are simply in the process of gifting him the next election regardless.

In Scotland, Nicola Sturgeon has conceded that independence will not be a panacea; the country, she says, will still be buffeted by challenges but will at least be able to take its own decisions in the national interest. Perhaps. The nationalists’ reputation has been soured, however, by a combination of distinct under-achievement and virtue-signalling. Independence is the party’s raison d’etre but the Scottish government’s insistence on a new referendum at the expense of everything else has become a distraction.

A grown-up acknowledgement of the problems that Scotland faces – and of the economic and political issues that are currently making life difficult for the major European economies – would not go amiss, either. And what are the SNP’s economic priorities for 2023? The opposition parties, too, ideally need to adopt a more grown-up approach and give us some sign that they have positive visions for Scotland.

It’s a lot to hope for, yes. But some hope is better than none at all.